Does East meet West? Towards a unified vision of the management of Nasopharyngeal carcinoma

Impact of Clinical Surveillance on Outcomes of Locally Recurrent Nasopharyngeal Carcinoma

BACKGROUND

Local recurrence of nasopharyngeal carcinoma (NPC) occurs in 10%-20% of patients, with salvage potential in early recurrences. Yet, clear surveillance protocols are lacking. We compare survival outcomes and suitability for salvage in symptomatic and incidentally detected locally recurrent NPC.

METHODS

Locally recurrent NPC patients, initially diagnosed at the National Cancer Center Singapore between October 2003 and November 2009, were identified. Demographics, symptoms, detection modalities, and survival outcomes were analyzed.

RESULTS

Eighty-two patients were studied. Median follow up and time to local recurrence was 5.51 and 2.19 years; 45.1% were symptomatic; 65.9% were diagnosed incidentally; 62.2% were offered salvage treatment. Symptomatic patients (vs. asymptomatic) had lower 5-year overall-survival (39.1% vs. 74.5%, p = 0.011). Nonincidental diagnoses (vs. incidental) had lower 5-year overall-survival (33.6% vs. 71.1%, p = 0.02). Incidentally-detected recurrences (vs. nonincidental) were more likely offered salvage treatment (75.9% vs. 35.7%, p < 0.001).

CONCLUSION

Routine clinical examination, nasoendoscopy, and imaging allow early detection of asymptomatic recurrences, with improved outcomes.

A Canadian Perspective on Systemic Therapy for Recurrent or Metastatic Nasopharyngeal Carcinoma

Although the majority of patients with nasopharyngeal carcinoma (NPC) present with early-stage or locoregional disease that can be treated with definitive radiotherapy, approximately 20% of patients experience disease recurrence, and 15% present with metastatic disease that is not amenable to curative therapy. Management of patients with recurrent or metastatic (r/m) NPC who are not candidates for local salvage therapy is challenging in Canada, as there is uncertainty in extrapolating evidence that is largely generated from Southeast China to non-endemic regions such as Canada. Currently, treatment options in Canada are limited to chemotherapy regimens that can only achieve short-term response and prolongation of survival. The addition of anti-PD-1 monoclonal antibodies to chemotherapy has been shown to extend progression-free survival in recurrent r/m NPC compared to chemotherapy alone; however, approval of PD-1 inhibitors in Canada has lagged behind other jurisdictions where NPC is non-endemic. This paper reviews the current systemic treatment landscape for r/m NPC in Canada, highlights unmet treatment needs for patients who are not candidates for curative therapy, and discusses the challenges and opportunities that lie in emerging therapies.

Global epidemiological profile in nasopharyngeal carcinoma: a prediction study

OBJECTIVES

This study delineates the global nasopharyngeal carcinoma's (NPC) incidence and mortality across 185 countries in 2020 and projects the disease's burden by 2040.

DESIGN

A prediction study.

SETTING

Countries within the 20 world regions.

PARTICIPANTS

Global NPC population.

PRIMARY AND SECONDARY OUTCOME MEASURES

The estimated counts of NPC cases and deaths were retrieved from the GLOBOCAN 2020 database. Age-standardised incidence rates (ASIR) and age-standardised death rates (ASDR) were computed. Projections for NPC by 2040 were derived from global population forecasts.

RESULTS

In the year 2020, East Asia emerged as the epicentre of both NPC incidences and mortalities, encompassing 49.39% (65 866 of the total 133 354 cases) and 45.56% (36 453 of the total 80 008 deaths), respectively, with China's contribution being the most substantial (46.82% of cases and 43.50% of deaths). The disparity between genders was notable, as the ASIR and ASDR for males were approximately triple those observed in females. The incidence exhibited regional diversity, with South-Eastern Asia and East Asia recording the highest ASIR for males and females (7.7 and 2.5, and 3.9 and 1.5 per 100 000 person-years, respectively). Similarly, South-Eastern Asia also reported the highest ASDR for both genders (5.4 and 1.5 per 100 000 person-years, respectively). Projections for 2040 anticipate a rise in annual cases and deaths to 179 476 (indicating a 34.58% increase from 2020) and 113 851 (reflecting a 42.29% increase), respectively. Further analysis revealed a correlation between the Human Development Index and disease burden.

CONCLUSIONS

NPC, primarily impacting East Asia and predominantly affecting men, is poised for a significant increase in incidence and mortality by 2040, especially in Asia.

Nasopharyngeal carcinoma survival by histology in endemic and non-endemic areas

BACKGROUND

To investigate the prognostic implications of histology among nasopharyngeal carcinoma (NPC) using the data from a Chinese cohort and the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

We included patients diagnosed with WHO II and III subtypes NPC from two independent cohorts (Xiamen [XM]-NPC cohort and SEER-NPC cohort).

RESULTS

We identified 726 patients in the XM-NPC cohort and 1334 patients in the SEER cohort. In the XM-NPC cohort, 94 (12.9%) and 632 (87.1%) patients had WHO II and III subtypes, respectively. In the SEER-NPC cohort, 839 (62.9%) and 495 (37.1%) patients had WHO II and III subtypes, respectively. WHO II subtype patients had a higher smoking rate than the WHO III subtype (57.4% vs. 43.4%) in the XM-NPC cohort. There were no significant differences in age, gender, tumor stage, or nodal stage between the two subtypes in both cohorts. In the XM-NPC cohort, patients with the WHO II subtype had worse locoregional relapse-free survival (82.2% vs. 89.5%, p = 0.063), distant metastasis-free survival (72.4% vs. 85.9%, p = 0.028), disease-free survival (61.6% vs. 78.8%, p = 0.003), and overall survival (OS) (71.7% vs. 84.0%, p = 0.035) than those with WHO III subtype. In the SEER-NPC cohort, patients with the WHO II subtype had worse NPC-specific survival (81.1% vs. 89.4%, p < 0.001) and OS (71.6% vs. 78.8%, p < 0.001) than those with WHO III subtype. The multivariate analysis showed that histology was an independent prognostic factor associated with outcomes in both cohorts.

CONCLUSIONS

Our study demonstrates the significant influence of histological subtypes on outcomes in NPC among various populations, highlighting substantial disparities between the WHO II and WHO III subtypes.

Molecular separation-assisted label-free SERS combined with machine learning for nasopharyngeal cancer screening and radiotherapy resistance prediction

Nasopharyngeal cancer (NPC) is a malignant tumor with high prevalence in Southeast Asia and highly invasive and metastatic characteristics. Radiotherapy is the primary strategy for NPC treatment, however there is still lack of effect method for predicting the radioresistance that is the main reason for treatment failure. Herein, the molecular profiles of patient plasma from NPC with radiotherapy sensitivity and resistance groups as well as healthy group, respectively, were explored by label-free surface enhanced Raman spectroscopy (SERS) based on surface plasmon resonance for the first time. Especially, the components with different molecular weight sizes were analyzed via the separation process, helping to avoid the possible missing of diagnostic information due to the competitive adsorption. Following that, robust machine learning algorithm based on principal component analysis and linear discriminant analysis (PCA-LDA) was employed to extract the feature of blood-SERS data and establish an effective predictive model with the accuracy of 96.7% for identifying the radiotherapy resistance subjects from sensitivity ones, and 100% for identifying the NPC subjects from healthy ones. This work demonstrates the potential of molecular separation-assisted label-free SERS combined with machine learning for NPC screening and treatment strategy guidance in clinical scenario.

Racial and Ethnic Disparities in Nasopharyngeal Cancer with an Emphasis among Asian Americans

Despite the overall decreasing incidence, nasopharyngeal cancer (NPC) continues to cause a significant health burden among Asian Americans (AAs), who are a fast-growing but understudied heterogeneous racial group in the United States. We aimed to examine the racial/ethnic disparities in NPC incidence, treatment, and mortality with a specific focus on AA subgroups. NPC patients aged ≥ 15 years were obtained from the Surveillance, Epidemiology, and End Results (SEER) 18 (1975-2018). AAs were divided into Chinese, Filipino, Vietnamese, Hawaiian, Japanese, Laotian, Korean, Cambodian, Indian/Pakistani and other Asian/Pacific Islanders (APIs). Age-adjusted incidence was calculated using the SEER*Stat software. Cox proportional and Fine-Gray sub-distribution hazard models were used to calculate overall and cause-specific mortalities after adjusting for confounders. Among the total 11,964 NPC cases, 18.4% were Chinese, 7.7% Filipino, 5.0% Vietnamese, 1.2% Hawaiian, 1.0% Japanese, 0.8% Laotian, 0.8% Korean, 0.6% Cambodian, 0.5% Indian/Pakistani and 4.4% other APIs. Laotians had the highest age-adjusted NPC incidence (9.21 per 100,000), which was 18.04 times higher than it in non-Hispanic Whites (NHWs). Chinese and Filipinos observed lower overall mortalities, however, Chinese saw increased NPC-specific mortality than NHWs. Disparities in mortality were also found across different histology subtypes. This is the first and largest study examining the NPC incidence and outcomes in AA subgroups. The significant disparities of NPC within AAs underline the importance of adequate AA-subgroup sample size in future studies to understand the prognostic role of ethnicity in NPC and advocate more ethnically and culturally tailored cancer prevention and care delivery.

Surveillance tools for detection of recurrent nasopharyngeal carcinoma: An evidence-based review and recommendations

Objective

Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.

Methods

MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age; histopathological reference standard; and modalities pertaining to imaging or microbiology.

Results

Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and ²⁰¹TI SPECT, and EBV DNA.

Conclusions

For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread; however, Tc-99m MIBI and ²⁰¹TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.

Immunotherapy in Nonendemic Nasopharyngeal Carcinoma: Real-World Data from Two Nonendemic Regions

BACKGROUND

nasopharyngeal carcinoma (NPC) is a complex disease entity that mainly predominates in endemic regions. Real-world data with immunotherapy from nonendemic regions are limited.

METHODS

we collected data from patients with recurrent/metastatic (R/M) NPC treated at a center in Greece and 8 centers in Italy. Between 2016 and 2021, 46 patients who were treated with at least one cycle of immune checkpoint inhibitors (ICI) were identified. Herein, we present our results and a review of the literature.

RESULTS

assessment of response was available in 42 patients. Overall, 11 patients responded to immunotherapy (Overall Response Rate-ORR 26.2%). Three patients had complete response (CR), and 8 patients had partial response (PR). Disease control rate (DCR) was 61.9%. Median Progression Free Survival (PFS) was 5.6 months and median Overall Survival (OS) was 19.1 months. Responders to ICI improved PFS and OS as compared to that of nonresponders. A lower probability of responding to ICI was shown in patients with more than three metastatic sites (p = 0.073), metastatic disease at initial diagnosis, (p = 0.039) or EBV DNA positive before ICI initiation, (p = 0.074). Decline in EBV DNA levels was found to be statistically significant associated with best response to ICI (p = 0.049). Safety was manageable.

CONCLUSIONS

among 46 patients with R/M NPC treated with immunotherapy in two nonendemic regions, ORR was 26.2% and durable responses were observed. Low disease burden could serve as a biomarker for response to ICI.

Treatment and outcomes of nasopharyngeal carcinoma in a unique non-endemic population

OBJECTIVE

Nasopharyngeal carcinoma (NPC) is common in Southeast Asia. Due to the influx of immigrants from this region, the incidence in British Columbia is increasing. Current literature from non-endemic populations encompasses heterogeneous cohorts. This study examines NPC in a North American population, with a high incidence, to understand the population's characteristics, treatment outcomes and recurrence patterns.

METHODS AND MATERIALS

A retrospective analysis of patients treated for primary and recurrent NPC over 15-years. Regression analyses were used to identify predictors of disease recurrence and death. A subgroup analysis of the locoregional recurrence cohort was conducted. Five-year survival outcomes were determined.

RESULTS

601 patients were included. Asian ethnicity comprised 77% and the majority had non-keratinizing carcinoma (81%). In total, 19.3% of patients experienced recurrence: 58% local, 22% regional and 20% distant. Five-year overall survival was 70%. Smoking, advancing T-stage, poorer performance status and advanced overall stage were all associated with worse overall survival (p < 0.05). Asian ethnicity improved overall survival but not recurrence free survival. Similar features in addition to non-keratinizing histology were associated with increased locoregional recurrence (p < 0.05). Competing risk analysis indicated radiotherapy alone had a higher recurrence relative to chemoradiotherapy (HR 1.91, CI 1.17-3.09, p = 0.01).

CONCLUSIONS

We report the largest study evaluating treatment and outcomes of NPC in a non-endemic population. This unique population falls between described endemic and non-endemic populations. Non-keratinizing pathology and primary radiotherapy did not affect survival; however, both had a propensity for recurrence. Finally, patients experienced more locoregional and less distant recurrence, supporting that this cohort may be amenable to curative salvage therapy.

Emerging therapeutic targets for nasopharyngeal carcinoma: opportunities and challenges

Introduction: Nasopharyngeal carcinoma (NPC) is a major public health problem in several countries, especially those in Southeast Asia and North Africa. In its typical poorly differentiated form, the Epstein-Barr virus (EBV) genome is present in the nuclei of all malignant cells with restricted expression of a few viral genes. The malignant phenotype of NPC cells results from the influence of these viral products in combination with cellular genetic, epigenetic and functional alterations. With regard to host/tumor interactions, NPC is a remarkable example of immune escape in the context of a hot tumor.Areas covered: This article has an emphasis on emerging therapeutic targets that are considered upstream or at an early stage of clinical application. It examines targets related to cellular oncogenic alterations, latent EBV infection and tumor interactions with the immune system.Expert opinion: There is a remarkable emergence of new agents that target EBV products. The clinical application of these agents would benefit from a systematic and comprehensive molecular classification of NPCs and from easy access to pre-clinical models in public repositories. There is a strong rationale for more investigations on the potential of immune modulators, especially those related to NK cells.

Prognostic Value of Circular RNA ciRS-7 in Various Cancers: A PRISMA-Compliant Meta-Analysis

BACKGROUND

Circular RNAs (circRNAs) have been shown to be involved in tumorigenesis. As a member of circRNAs, ciRS-7 is thought to be a negative prognostic indicator in multiple types of cancer. The present study aimed to comprehensively explore the value of ciRS-7 in tumor malignancy. Materials and Methods. A systematic review of PubMed, Web of Science, and the Cochrane library was carried out to examine the related studies. The pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated from the available publications by STATA 12.0. Subgroup analysis, publication bias, sensitivity analysis, and meta-regression were conducted.

RESULTS

This meta-analysis included 1,714 patients from 13 cohorts. The results suggested that high ciRS-7 expression was significantly associated with overall survival (OS) (HR = 2.17, 95% CI = 1.50-3.15, P < 0.001) in various cancers. Stratified analyses indicated that elevated levels of ciRS-7 appeared to be a powerful prognostic biomarker for patients with non-small-cell lung cancer (NSCLC) (HR: 2.50, 95% CI: 1.07-6.07, P < 0.001) in various cancers. Stratified analyses indicated that elevated levels of ciRS-7 appeared to be a powerful prognostic biomarker for patients with non-small-cell lung cancer (NSCLC) (HR: 2.50, 95% CI: 1.07-6.07, P < 0.001) in various cancers. Stratified analyses indicated that elevated levels of ciRS-7 appeared to be a powerful prognostic biomarker for patients with non-small-cell lung cancer (NSCLC) (HR: 2.50, 95% CI: 1.07-6.07, P < 0.001) in various cancers. Stratified analyses indicated that elevated levels of ciRS-7 appeared to be a powerful prognostic biomarker for patients with non-small-cell lung cancer (NSCLC) (HR: 2.50, 95% CI: 1.07-6.07, P < 0.001) in various cancers. Stratified analyses indicated that elevated levels of ciRS-7 appeared to be a powerful prognostic biomarker for patients with non-small-cell lung cancer (NSCLC) (HR: 2.50, 95% CI: 1.07-6.07.

CONCLUSIONS

High expression of ciRS-7 has a significant correlation with the high stage in various cancers, and ciRS-7 is intimately associated with an adverse OS in numerous cancers. Thus, ciRS-7 may act as a potential biomarker for the development of malignancies.